Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
AJR Am J Roentgenol. 2010 Jan;194(1):85-92. doi: 10.2214/AJR.09.2652.
Evaluations of stents by MDCT from studies performed at single centers have yielded variable results with a high proportion of unassessable stents. The purpose of this study was to evaluate the accuracy of 64-MDCT angiography (MDCTA) in identifying in-stent restenosis in a multicenter trial.
The Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography Using 64 Detectors (CORE-64) Multicenter Trial and Registry evaluated the accuracy of 64-MDCTA in assessing 405 patients referred for coronary angiography. A total of 75 stents in 52 patients were assessed: 48 of 75 stents (64%) in 36 of 52 patients (69%) could be evaluated. The prevalence of in-stent restenosis by quantitative coronary angiography (QCA) in this subgroup was 23% (17/75). Eighty percent of the stents were <or=3.0 mm in diameter.
The overall sensitivity, specificity, positive predictive value, and negative predictive value to detect 50% in-stent stenosis visually using MDCT compared with QCA was 33.3%, 91.7%, 57.1%, and 80.5%, respectively, with an overall accuracy of 77.1% for the 48 assessable stents. The ability to evaluate stents on MDCTA varied by stent type: Thick-strut stents such as Bx Velocity were assessable in 50% of the cases; Cypher, 62.5% of the cases; and thinner-strut stents such as Taxus, 75% of the cases. We performed quantitative assessment of in-stent contrast attenuation in Hounsfield units and correlated that value with the quantitative percentage of stenosis by QCA. The correlation coefficient between the average attenuation decrease and >or=50% stenosis by QCA was 0.25 (p=0.073). Quantitative assessment failed to improve the accuracy of MDCT over qualitative assessment.
The results of our study showed that 64-MDCT has poor ability to detect in-stent restenosis in small-diameter stents. Evaluability and negative predictive value were better in large-diameter stents. Thus, 64-MDCT may be appropriate for stent assessment in only selected patients.
来自单中心研究的 MDCT 对支架的评估结果存在差异，其中很大一部分支架无法评估。本研究旨在评估 64 层 MDCT 血管造影（MDCTA）在多中心试验中识别支架内再狭窄的准确性。
冠状动脉评估使用多排螺旋 CT 血管造影 64 探测器（CORE-64）多中心试验和注册评估了 64-MDCTA 评估 405 例冠状动脉造影患者的准确性。52 例患者中有 75 个支架进行了评估：52 例患者中有 36 例（69%）的 75 个支架中的 48 个（64%）可以评估。该亚组定量冠状动脉造影（QCA）的支架内再狭窄发生率为 23%（17/75）。80%的支架直径小于或等于 3.0mm。
使用 MDCT 与 QCA 相比，视觉检测 50%支架内狭窄的总体敏感性、特异性、阳性预测值和阴性预测值分别为 33.3%、91.7%、57.1%和 80.5%，48 个可评估支架的总体准确性为 77.1%。支架的 MDCTA 评估能力因支架类型而异：Bx Velocity 等厚壁支架的可评估率为 50%；Cypher 的可评估率为 62.5%；Taxus 等薄壁支架的可评估率为 75%。我们对支架内的 CT 值衰减进行了定量评估，并将该值与 QCA 定量的狭窄百分比进行了相关性分析。平均衰减降低值与 QCA ＞50%狭窄的相关系数为 0.25（p=0.073）。定量评估并不能提高 MDCT 对定性评估的准确性。
本研究结果表明，64-MDCT 检测小直径支架内再狭窄的能力较差。大直径支架的可评估性和阴性预测值更好。因此，64-MDCT 可能仅适用于特定患者的支架评估。
